Inspection on 08/07/08 for St Erme

This inspection was carried out on 8th July 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Erme 24/11/09

St Erme 02/12/08

St Erme 12/12/07

St Erme 14/08/07

St Erme 07/03/07

St Erme 24/07/06

St Erme 16/02/06

St Erme 27/09/05

St Erme 11/11/04

St Erme 27/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 St Erme Trispen Truro Cornwall TR4 9BW Lead Inspector Lynda Kirtland Unannounced Inspection 8th July 2008 9:10 St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Erme Address Trispen Truro Cornwall TR4 9BW 01872 263355 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mail@dcact.org Spectrum Manager post vacant Care Home 20 Category(ies) of Learning disability (20) registration, with number of places St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. St Erme House - up to 10 adults with a Learning Disability (LD) The Lodge - up to 9 adults with a Learning Disability (LD) St Michaels - up to 3 adults with a Learning Disability (LD) Total number of service users not to exceed a maximum of 20 Date of last inspection 12th December 2007 Brief Description of the Service: St. Erme campus is a care home providing accommodation and personal care for up to 20 adults with a learning disability. The home is run by Spectrum, an organisation that specialises in providing specialist care for people with autism. The home comprises of three separate, self-contained units: St. Erme House has undergone a major refurbishment and now provides accommodation for up to five adults in the main house. People who use the service have separate bedrooms, some of which are en suite and their own lounge. They share a communal lounge; dining area/kitchenette and can access the main kitchen with staff support. People who use the service were involved in the décor and furnishing of the property, which is to a high standard. There are secure gardens attached to the house. There is a self contained flat attached to the house for one person. The Lodge currently accommodates four people. People who use the service have their own bedrooms, and share bathroom, lounge, dining, and kitchen facilities there are access to a secure garden area. The Lodge is currently undergoing major refurbishment and Spectrum is planning for this home to become a specialist assessment unit in the future. St. Michaels can accommodate up to three people. People who use the service have their own bedroom and share lounge, dining, kitchen and bathroom facilities. One person has their own ‘flat’ with all amenities included. On site there is a separate administrative block with a visiting lounge for people who use the service to meet with relatives and visitors in private. The properties have been adapted to meet a range of needs and there is some disabled access. The property is set in its own, extensive grounds, slightly off the road. It is situated in the village of Trispen, which is close to the city of Truro. Current fees range from £818.00 per week to £3018. There are variable additional charges to individuals for personal items such as hairdressing, newspapers, confectionary, private chiropody and off-site entertainment. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. Two regulation inspectors and a Pharmacy inspector visited St Erme campus to undertake a key unannounced inspection on the 8 July 2008 and were there for approximately 7 hours. An inspector visited the home the following day and was there for a further 4 hours. The purpose of the inspection was to ensure that the needs of people who use the service are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that people living in the home receive good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with some people who use the service, members of staff, and the management team were interviewed and there were opportunities to directly observe aspects of people’s daily lives in the home and staff interaction with them. In addition we received four staff surveys. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with members of Spectrum management team and the prospective registered managers. The principle method of inspection was “case tracking”. This involves meeting with a select number of people who use the service, staff caring for them and examination of records relating to their care. This provides a useful impression of how the home is working for people who use the service overall. In total four people from the differing units were case tracked in detail at this inspection. The Annual Quality Assurance Assessment, which is a questionnaire that the registered manager completes, was received. The AQAA describes the services and facilities that St Erme provide and identifies what areas they do well in and where they want to make further improvements. What the service does well: In all units, when admissions are planned it is evident that people who use the service are admitted to the home on the basis of an assessment, so that they can be confident it will be suitable for them and meet their needs. Transitional work had occurred which allowed people who use the service and their relatives to be fully involved and consulted about the planned move to their new home. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 6 People who use the service have detailed written care plans, which set out their personal, health and social needs in full and are regularly reviewed. These are shared with their relatives and social workers and they are invited to state their views so that they are kept informed about the progress of the person in the home. Their care plans consider their skills in making decisions with a view to enabling them to develop their abilities in this respect. Person Centred planning (PCP) is being introduced for all individuals, which identifies individual aspirations to reach certain goals i.e. to become more independent in self-care skills. People who use the service have good access to health provision and records of all appointments are kept. People who use the service are helped to maintain valued relationships with their families and friends outside of the home, where possible. They are provided with an appropriate range of healthy meals and staff assists them to make choices so that they stay well and enjoy the food provided to them. There is evidence that people who use the service are provided with a range of varied and appropriate activities especially within the community. There are satisfactory systems in place to ensure that people who use the service or their representatives know about their rights to make complaints if they are dissatisfied with the care and services provided to them at the home. There are satisfactory Safeguarding procedures in place so that staff are aware of what action to take if they believe a person in their care is at risk of abuse. There is a robust recruitment process so that care staff are selected fairly and on the basis that they are fit and suitable to work with vulnerable adults in a care setting allowing people who use the service and their representatives to have confidence in the staff caring for them. All staff receive induction training before they start to work in the home. There are systems in place to formally consult with people who use the service and their relatives about the quality of the care and services provided, including questionnaires, reviews and opportunities for them to make their views known less formally. Due to the new managers at St Erme this is in process and they need to send these findings and any action plan to the commission when completed. Spectrum have designed a Restrictive practice Audit which identifies practices and environmental adaptations that have restricting or controlling consequences for individuals who use the service. From this Spectrum aim to promote more freedom within the home for people who use the service. In addition staff are undergoing updated training in the area of managing challenging behaviours. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The management team have reviewed The Lodge aims/philosophy and have made this unit a specialist assessment centre. Job descriptions for staff have been reviewed and a new training pack in behavioural management is now provided to staff. Staff spoke positively about this work and felt that the team ‘atmosphere’ in the Lodge had improved. The previous requirement to ensure that the management team promote the whistle blowing policy and procedure has been actioned. Staff stated they felt more able to approach the current management team and discuss any concerns with them and felt they would be listened to with no repercussions. The management team have reviewed Spectrums Restrictive Practices Audit for each person in the home and how risk assessments will be incorporated in the care planning process. This is ongoing work. Staff welcome this move, as they want further clarity on how to manage risks better. St Erme House has had a major refurbishment, which has resulted in a homely and comfortable atmosphere. All the rooms are decorated and furnished to a high standard. St Michaels has been redecorated throughout and new furnishings had been purchased. In the Lodge the ground floor has been refurbished and redecorated with new furnishings making it a more attractive area to live. The manager said that the first floor of The Lodge would be redecorated/ redesigned in the near future. Staffing levels in all units have been reviewed resulting in an increase in staffing in all units. Staff in the main expressed satisfaction with the level of staffing on duty but were aware that the rotas are not able to account for staff sickness/ leave/ training and hence there can be times when not all activities for people who use the service are able to occur – please see section below. It is encouraging to the commission that a review of staffing levels has led to a increase in numbers especially over night so that staff are no longer working on their own. An overview of staff training in each unit has been produced so that managers are aware of what training staff have completed or need to attend. The managers are commencing formal staff supervision. The Commission observed a competent motivated and skilled staff group who managed situations as a team and supported each other well. Staff also said that they felt they received support from their direct line managers. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 8 What they could do better: The units need to update their Statement Of Purpose and Service Users guide to show the management changes in the home and make them more personalised detailing what services and facilities each unit provides. It would benefit from further expansion as currently the documents provide statements as to what care they aim to provide but does not demonstrate how this will be put into action. With emergency admissions a care plan must be implemented within 5 working days. The care plan that staff were using was dated and staff informed inspectors that they were reliant on personal knowledge of the individual, as the care plan did not reflect the individuals needs. Management team said that the care plan had been reviewed but no documentation was able to evidence this. Care plans should be provided to people who use the service in more meaningful ways, with clear and specific goals, so that they can participate more directly in making decisions about their lives. As with individual risk assessments these should also be provided to people who use the service in more meaningful ways so that they are aware of the reasoning behind for example a particular restriction/ risk and what actions will be taken to minimise the risk. It is acknowledged that the management team are working to address in particular the format of risk assessments. Staff confirmed that activities do rely on enough staff being present and therefore on occasions activities, which are planned, are missed. The manager of The house had already highlighted this issue, and this was observed at the Lodge during the inspection (as someone was off work sick) and has agreed to review this. Four immediate requirements were identified in respect of medication practices, as the homes practices are unsafe. It is of serious concern that mediation issues have been highlighted in previous reports and whilst there were some improvements noted in the last inspection report, these have not been maintained but deteriorated. The Commission has written to Spectrum to inform them that failure to comply with the immediate requirements will result in enforcement action being considered. As recommended at the last inspection the complaints policy needs to be reviewed so that it refers to the fact that anyone can contact the Commission at anytime to voice concerns, and should have contact details of the placing authority Department Of Adult Social Care included in it. As this was a recommendation and not acted upon a requirement to this effect has been made. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 9 It is recommended that the manager attend the Multi Disciplinary Safeguarding course so that she expands her knowledge in this area for the protection of those living at the home. People who use the service It is recommended that each unit has a policy and procedure in the management of peoples monies i.e. the process in withdrawing/ depositing monies and that this is made appropriate to the individual units. Plans to modernise and improve the home’s environment need to continue to be implemented so that all people who use the service benefit from comfortable and homely surroundings in which they can develop their skills and independence in the future. As identified in the last report inspectors discussed with staff and managers that there is a large amount of paperwork relating to the persons care. It is recommended that the management team review the organisation of the documents so that staff are more able to access information quickly. In addition as staff are being given more responsibility to complete care plans and monthly reviews they need administration time to complete this task which is currently lacking and has led to some documentation not being completed. This requirement is re notified, failure to comply might result in the Commission taking enforcement action. From discussions with managers they were aware that when looking at the individual people who use the service risks assessments there were insufficient staffing levels at times to take them all out safely as the risk assessment identifies a higher level of staffing. The manager must ensure that the correct staffing levels are available as per the individual risk assessment both in and outside of the home. In addition when risk assessing and reviewing staff levels on group activities this must also be considered to ensure that sufficient staff are with people who use the service at all times which correspond to their risk assessments. A greater proportion of the care staff in all units should achieve formal qualifications so that people who use the service and their representatives can be assured of their competence to work effectively with them. Staff supervision is commencing with the newly appointed managers. All staff should receive a minimum of 6 supervision sessions a year. It is of concern that Spectrum has cancelled training for the last four months and has not informed the commission of the reason for this officially or when it is proposed that training will be resumed. The management team must write to the Commission informing them of the reasons for its cancellation and when training will be resumed. The registered manager applications must be submitted to the Commission as the home is operating illegally. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 10 Due to the homes poor quality rating the commission request that copies of the regulation 26 reports are sent to them so that we can be kept up to date with progress made. The managers were reminded to ensure that the communications book adheres to the Data protection Act and does not hold personal information on People who use the service in the one place. Daily logs should be maintained on a daily basis so that care provided is accounted for. The inspector would like to thank people who use the service, their relatives, staff and the management teams for their assistance during this inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information provided to people who use the service must be up to date and individualised so that they are aware of what facilities, services and management arrangements will be provided in their particular unit. Further expansion as to how they will meet the person’s needs would be beneficial. The majority of people’s needs are assessed prior to admission. Care plans should be implemented with emergency admissions so that staff know the individuals needs and can meet them in a consistent manner. EVIDENCE: Since the last inspection there has been a change in the management team. Therefore the homes Statement Of Purpose and Service Users guide must be amended to reflect this. They do describe the facilities and services that they offer. However they would benefit from further expansion as currently the documents state what they intend to do but do not say how this will be put into action. The three units all provide a different service. The majority of people who use the service have lived with each other for some time and therefore know each other and the campus well. In three cases inspected it was evident that pre admission assessments occur to determine if the service will be able to meet the person’s individual needs before moving into the home. The Lodge has recently had an emergency admission, however the care plan was old, from his previous placement and there was no evidence St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 13 of reviews. In discussion with staff they stated that they were reliant on certain staff that knew the individual previously to know what the persons needs were and how to approach them. Staff commented that ‘shadowing’ the staff that knew the individual has worked well but all agreed that there is no current care plan available to work with. In speaking with the management team they said they have reviewed the individuals care plan but no documentation to this effect was seen. People who use the service have a statement of terms and conditions that identifies the care they will be provided and reflects the costings that the individual has to pay towards their care. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 14 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service have detailed written care plans, which address their personal, health and social care needs but these should be provided to them in more meaningful and accessible formats so that they have greater opportunities to participate in the care planning process. People who use the service need to be provided with improved opportunities to make decisions about things that are important to them to improve the quality of their lives. Individual risk assessments reflect any necessary restrictions to protect them and/or other people, which should be minimal and only in their best interests EVIDENCE: From the four people case tracked documents showed that three people had an up to date detailed care plan, which addresses all their needs and informs, guides and directs staff on what interventions are needed to provide care. In addition a ‘micro’ care plan has been introduced for staff to access as a ‘quick guide’ of specific care needs and how this is to be provided in a consistent manner. This is again detailed and directive informing staff for example on what phrases to use to assist a person in their self care tasks. Person Centred Planning is being introduced for all people who use the service so that individuals ‘milestones’ and ‘aspirations’ can be identified more easily and St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 15 planned work to meet the aspiration can then be identified i.e. to develop personal self-care skills such as grooming. It is recommended that the care plan documentation be reviewed so they can be in accessible or meaningful formats for people who use the service. As in the previous inspection, Inspectors discussed with staff and managers that there is a large amount of paperwork relating to the persons care. The information on how to provide care is there but it can take sometime to find it. Staff agreed that it is difficult to know at times which document is the most up to date and therefore they rely on their own knowledge of a person rather than looking at the care plans to ensure that care is provided in the most appropriate way. It is again recommended that the management team review the organisation of the documents so that staff are more able to access information quickly. In discussion with Spectrums psychologist and behavioural director they are reviewing the risk assessment process and aim to include in the care plans all potential/ perceived risks and how these will be managed. The management team and staff all acknowledge that the current risk assessments need to be reviewed to ensure that all staff are directed, informed and guided in how to manage individual risks in a consistent manner. Spectrum has undertaken an internal review of all its restrictive practises for People who use the service to ensure that any restrictions placed on them are necessary and in their best interests. Spectrum has reviewed all people residing at St Erme and is where possible placing controls which are ‘least restrictive’. These cross-reference with the individuals risk assessments however they are not provided to them in accessible formats. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16, 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The majority of people who use the service have a range of external and internal activities that they can participate in the local community. People who use the service are assisted to maintain valued relationships so that they enjoy a good quality of life. They are provided with information about their rights and responsibilities so that they are aware of what is provided and what is expected of them as residents EVIDENCE: It was evidenced from discussion/ observation with people who use the service, staff and documentation that people who use the service attend a variety of activities both in-house and externally. For example trampoline, horse riding, gardening, swimming and walks. Staff support them to access these resources in the local community, which was confirmed through daily care records and observation during the inspection. With the implementation of Person Centred Planning the individual’s activities are identified, and where possible responded. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 17 Staff confirmed that activities do rely on enough staff being present and therefore on occasions activities, which are planned, are missed. This needs to be reviewed. Please refer to staffing section. People who use the service care plans and risk assessments consider their needs with regard to their developing and maintaining relationships with their families and friends. An Environmental Health inspection occurred in December 2007, which did not identify any concerns. Records showed that there is a varied and nutritional menu available to all people who use the service and the manager of The lodge/ ST Michaels stated that a dietician was consulted to look at the menus to ensure that they food provided was nutritious. There was sufficient food available in all the units, and some were due to go shopping to stock up cupboards. Some of the People who use the service assist in the preparation of meals, choices in menu, laying of tables and clearing items away. People who use the service have raised no concerns regarding food. Staff confirmed that if an individual did not wish to eat the main meal on offer that day an alternative would be provided. Managers stated that the majority of staff have attended food hygiene course or are booked to attend this. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who use the service are supported with regard to their personal care. People who use the service have access to appropriate health care services. Medication processes are unsafe so that the consequences of this are that people who use the service are not protected from potential harm due to medication errors. EVIDENCE: Staff are provided with clear written guidelines on how to support people who use the service to maintain their personal appearance and hygiene. In all three units it was evident from inspecting healthcare records that people who use the service have access to a range of NHS provision, for example: community learning disability team, psychologist, psychiatric team, dentist, optician to name a few. The units have all been given ‘Health Action Plan for people with a Learning Disability’ folder from the Cornwall partnership trust. The unit managers will be completing these. In all three units we found that although a secure medicines cupboard is provided and is locked when not in use the key to this cupboard is not stored securely and as such means that medicines can be accessed by all members of St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 19 staff not just those trained or delegated with the responsibility of administering the medicines. In one unit it was observed that a seal had been broken on one bottle of medicine although none had been recorded as being administered, it was not possible to determine who had broken the seal or if the medicine had been used. An immediate requirement was left to address this issue. We found that in each unit there were medicines that the manufacturer had specified a reduced expiry date after opening, in two of the unit these were nasal sprays where it was not possible to determine when they had been opened so that there was a possibility that the person receiving the medicine may be receiving a product that is less effective that the manufacturer intended. In the other unit we observed a skin solution being applied where there were three bottles present with expiry dates of 01/04/08, 29/04/08, and 27/05/08. This person had the cream applied in the office in front of an inspector, which compromised his privacy and dignity. Within the homes own policy there is a statement that all staff administering medicines must check the expiry date of medicines each time they are to be used. An immediate requirement was left to address this issue and obtain replacement supplies of these medicines. We found that the homes policy stated that “medicines are to be recorded out in entirety and then a complete record is to be made on return”. We observed a member of staff taking medicines out from the home, the records made did not include the quantity of medicine removed and only related to one medicine when it was observed that they had actually taken two different medicines with them. We also observed that on a previous occasion that medicines had been recorded as taken out from the home but no subsequent record had been made to record the return of them into the home. This means that the home is not able to audit what stock of medicine should be present in the home and may lead to medicines not being available if people need them. An immediate requirement was left to address this issue. When looking at the Medication Administration Record charts we found that some people were prescribed medicines to be administered “when required”. For some of these people within their plans of care there was good information around how these were to be used, where for others there was no indication of when they should be used. For all these medicines we found that no outcome of expected effect was documented and for some medicines the length of time they were to be administered for was not recorded. An immediate requirement was left to address this issue. We were also told that the home is registering members of staff to have update medication training using a distance-learning package. This will ensure that people receiving medicines do so from trained members of staff. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are satisfactory arrangements in place to enable people who use the service and their relatives to make their views known and to ensure that they are taken seriously and acted upon. There are policies in place to ensure that people who use the service are adequately protected from abuse. Staff feel able to express appropriate concerns to the management team in respect of people who use the service welfare EVIDENCE: People who use the service are provided with written and in some cases pictorial copies of the home’s formal complaints procedure and have formal and informal opportunities to raise any concerns with staff before they become serious complaints. This policy needs to refer to the fact that anyone can contact the Commission at anytime to voice concerns, and should have contact details of the placing authority Department Of Adult Social Care included in it. None of the units have received any formal complaints, nor has the Commission since the last inspection. We have received one expression of concerns, which is being investigated by the department of Adult Social care. The home has written procedures to guide staff on what to do if they suspect a person is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. People who use the service are not isolated in the home, but take part in a range of activities in the local community and St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 21 have relationships with people from outside of the home that they can communicate serious concerns to. In discussion with staff and from staff surveys, all commented that with the change in the management team at St Erme, particularly in the lodge/ St Michaels, they felt able to approach the manager with any concerns that they have. They stated they felt that the manager would listen to their concerns and act upon them. They no longer felt that there would be repercussions, as previously stated at the last inspection if they raised concerns. One manager has attended the Safeguarding course; it is recommended that the remaining manager attend this course. The home does have a copy of the Cornwall Multi agency adult protection procedure. Staff are attending in house adult protection training. People who use the service monies were inspected at the House as records were on site. Records for St Michaels and The Lodge were being by Spectrum headquarters and therefore not able to be inspected on this occasion. From inspecting monies it was evident that records were clear and up to date and supported by receipts. It is recommended that each unit implement a policy and procedure for how they manage individuals’ monies and what processes are needed to withdraw, deposit monies as each unit does this in a slightly different way. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Following the refurbishment in St Erme House it provides a high standard of accommodation. People who use the service were consulted on its décor and furnishings. The environment in The Lodge and St Michaels is undergoing redecoration and refurbishment. There are satisfactory systems in place to maintain hygiene in the home. EVIDENCE: St Erme House has undergone a major refurbishment. People who use the service were involved in choosing the décor and furnishings of their rooms. Each person has a separate bedroom plus own lounge area, and share the communal lounges, dining area and kitchen. They have keys to their own rooms and designated bathroom facilities. The home offers a high standard of comfort throughout and a secure garden area. The ground floor of The Lodge has been redesigned and refurbished. There is a new kitchen area, which people who use the service can access. The dining area has been redecorated and refurbished. The lounge are has been St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 23 separated into two rooms and allows people who use the service the opportunity to choose which room they would like to use, one of which is a quieter area. These rooms have all been redecorated and refurbished. The manager said that the first floor level refurbishment is ongoing with planned works to install en suite facilities and redecorate rooms upstairs. There is a secure garden for people who use the service use. St Michaels has been redecorated and refurbished. However the facility remains empty of any design/ character and staff acknowledge that they would not choose to spend time in the living areas as it is barren i.e. no carpet, painted magnolia and just has two sofas and a TV in the lounge. Individual rooms are more personalised. In respect of cleanliness, all three units were cleaned to a satisfactory standard. New staff undertakes infection control and basic food hygiene training as part of their induction and existing staff have good access to ongoing training in this respect. Laundry doors are marked to be kept closed where they lead off from food preparation areas and there are suitable laundry facilities to manage heavily soiled laundry and to prevent infection spreading through the home. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33, 34, 35, 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staffing levels need to be reviewed to ensure that there are sufficient staff on duty at all times to ensure that people who use the service have access to their planned daily activities. A greater proportion of the staff team should achieve formal qualifications so that people who use the service can have confidence in their competence. Staff are recruited fairly, safely and effectively on the basis that they are suitable to work with vulnerable adults in a care setting. Access to training has been suspended by Spectrum and must be resumed, so that people who use the service can be confident that they have the training they need to be able to work safely in the home. Formal supervision of staff needs to be improved. EVIDENCE: St Erme House: rotas showed that there are four staff members on shift during the day/ evening; the manager stated that minimum staffing ratios have risen from 3 to 4 members of staff plus an increase of sleeping in staff to two. This has been risk assessed to ensure that people who use the service and staff are not placed at any unnecessary risks. The manager stated that the use of bank staff is minimal. The manger has been in post since March 2008 and is currently reviewing staff levels, as she is aware that if all People who use the St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 25 service undertake their activities there are insufficient staffing levels to do this. However she then approaches her staff team/ bank to undertake extra shifts to ensure that all the People who use the service are appropriately supervised on their activities. The Lodge: rotas showed that for the current people who live at the Lodge, there are seven staff members on shift up until 6pm, this then reduces to six till 10pm. At night there are two waking night staff plus one member of staff sleeps in. This is an increase in staffing due to dependency needs. Staff in this unit felt that there were sufficient staff on duty but when a member of staff goes off work sick this can create difficulties which at times has lead to peoples activities being postponed until extra staff are identified to enable this to happen. The staff team feel that with the recent recruitment to this unit, plus manager changes, that they work much better as a ‘team’ and that this has led to more consistent care with People who use the service. St Michaels: The manager stated that staffing levels have been reviewed and have been increased, especially as the unit is now fully occupied The current staff on duty is four during the day (was 3) and three in the evening (previously 2) plus one waking night. The manager and deputy manager feels that this is sufficient. The manager stated with the appointment of a new member of staff the next day there are no care staff vacancies at St Michaels. As discussed in the previous inspection, we discussed with staff and managers that there is a large amount of paperwork relating to the persons care. As staff are being given more responsibility to complete care plans and monthly reviews they need administration time to complete this task which is currently lacking and has led to some documentation not being completed. This is again recommended to be addressed. As discussed previously in this report and the previous Key Inspection report (dated 12/12/07) risk assessments are being reviewed. Managers are aware that when looking at the individual people who use the service risks assessments they must ensure that sufficient staffing levels are available at all times to take individuals out safely as per the risk assessment and care plan both in and outside of the home. In addition when risk assessing and reviewing staff levels on group activities this must also be considered to ensure that sufficient staff are with people who use the service at all times which correspond to their risk assessments. All managers of the units stated that fewer than half of the care staff has formal qualifications at the minimum recommended level although most are working towards achieving them. Records of staff training confirmed this. All three units have a staff training overview, which clearly shows the training staff have completed or need to attend. What is of concern is that Spectrum has cancelled training for the last 4 months an official reason has not been given to us, but staff are stating it is because of staff shortages. It is of St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 26 concern that’s staff are not having access to up date training. A requirement to this effect has been identified. Staff recruitment records show that recruitment is fair and effective in that job applicants are tested against pre-set criteria, having submitted an application form and safe in that checks are made that they are suitable to work with vulnerable adults in a care setting. Staff members commented they received formal induction training on taking up their post. The Commission observed a competent, motivated and skilled staff group who managed situations as a team and supported each other well. Staff felt that they received support from the management team following incidents at local level. Each unit hold staff team meetings and minutes of the most recent meetings were seen. Supervision in all three units is commencing; each unit must ensure that supervision occurs a minimum of six times a year as per the guidelines of the national minimum standards. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. St Erme has no registered manager with the Commission for some time. St Erme is operating illegally as a care home. Applications must be made to the Commission to ensure that the managers are fit to run a care home for the best interests for the People who use the service. There are satisfactory systems in place to monitor the quality of the services provided so that it can be improved for the benefit of the People who use the service. The health and safety procedures in the home are satisfactory EVIDENCE: St Erme has no registered manager. St Erme has had a number of manager changes since 2003. Applications must be made to the Commission to register a manager as the home is operating illegally. In the interim Spectrum have appointed managers in The House (Dee Benny) and The lodge/St Michaels (Siobhan Sinnott). Both have experience of being a St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 28 registered manager in other Spectrum homes and are knowledgeable in Spectrums policies, procedures and philosophy. Both have gained the NVQ 4 in care and are keen to continue to update their knowledge and training. They are in the process of applying to the commission for the registered manager posts at the units they are managing. The staff team stated that the felt the change of management in the home has had a positive effect and felt that they could approach the managers with any queries, concerns and felt that they would be listened too. Staff surveys also echoed this. As the managers are new to the campus they will be implementing a quality assurance system in the near future. Therefore was not inspected on this occasion. The units have a monthly monitoring process, known as regulation 26 and the Commission must receive copies of these reports due to the homes quality rating. All three units have a variety of risk assessments in respect of working practices that are in the process of being reviewed. The recent Environmental health inspection did not identify any concerns. Fire risk assessments are completed and staff training in this area is undertaken on a regular bases. It was observed that fire doors were not wedged open in any units and that appropriate fire arrangements have been installed so that fire doors are now linked into the fire system. The managers were reminded to ensure that the communication book adheres to the data protection Act and does not hold personal information on people who use the service in the one place. It is also recommended that daily logbooks kept on individuals are numbered so that any pages that are torn out of books (as was observed) are accounted for and the reason why. Staff need to ensure that daily logs are completed daily as there were some gaps. In discussion with managers it was clear that administration time is needed, especially for The House where the manager and deputy have only 18 hours per week to complete all administration tasks. This needs urgent review. St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 1 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 1 X 3 X 2 3 X St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA4 Regulation 14 (1)(2) 15 (1) Requirement A care plan must be implemented within five working days of admission, identifying the individual’s needs to guide, inform and direct staff in how to provide care in a consistent manner. (The Lodge) Arrangements must be made to ensure that all medicines in the home are stored securely, and that keys to the cupboards are also kept securely. An immediate requirement was left to address this issue. (All units) Arrangements must be made to obtain a replacement supply of all medicines that may have passed their expiry date by 09/07/08 and a system in place to monitor the expiry dates of medicines. Timescale for action 30/08/08 2 YA20 13(2) 08/07/08 3 YA20 13(2) 08/08/08 St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 31 4 YA20 13(2) 5 YA20 13(2) 6 YA22 22 (7) An immediate requirement was left to address this issue. (All units) Arrangements must be made to ensure that there is a complete and accurate record of all medicines received into and leaving the home. An immediate requirement was left to address this issue. (Lodge and St Michaels) Arrangements must be made to develop clear protocols for the use of medicines prescribed to be used “when required”. An immediate requirement was left to address this issue. (All units) The complaints policy must be expanded so that anyone wishing to make a complaint knows they can contact the Commission at anytime plus have the funding local authority contact details. 09/07/08 08/08/08 30/09/08 7 YA31 17(1)(3)(a)15(1)(2) Administration time must be incorporated in the staffing rota for managers, deputy and care staff to enable them to undertake the administrative duties of their work(all units) This is re-notified to you, previous timescale for compliance 29/2/08 18(1) (c)(i)(ii) The Responsible Individual must write to the Commission to inform DS0000009149.V366267.R01.S.doc 30/11/08 8 YA35 30/08/08 St Erme Version 5.2 Page 32 them why training for staff has been cancelled and when it is to resume. This is to ensure that staff are kept up to date with their knowledge and skills. 9 YA37 8,9 The registered manager application must be completed (ST Erme campus) This is re notified previous dates of compliance 30/3/08 The summary of the quality assurance findings, when completed must be forwarded to the commission with an action plan. (ST Erme House, lodge and St Michaels) This is re-notified to you previous date of compliance 30/3/08 30/08/08 10 YA39 24 30/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The homes Statement Of Purpose should be expanded further so that the statements in the document in how they will provide care will be expanded to say how they will put this in to action. People who use the service care plans should be provided to them in meaningful formats, which are directly accessible to them, with clear and specific goals. DS0000009149.V366267.R01.S.doc Version 5.2 Page 33 2 YA6 St Erme (ST Erme House, lodge and St Michaels) 3 YA7 People who use the service risk assessments should be provided to them in meaningful formats, which are directly accessible to them, as far as is practicable. (ST Erme House, lodge and St Michaels) People who use the service files should be reviewed so that up to date information is easily accessible for staff to use so that they can provide consistent care to the individual. The manager should attend the Multi Agency Safeguarding course so that her knowledge in this process is expanded. Each unit should implement a procedure in how to manage People who use the service monies so that staff has clarity in how to withdraw/ deposit monies on their behalf for the individual’s protection. The planned refurbishment of the first floor of The Lodge should continue to provide People who use the service with a better standard of accommodation and furnishings Staffing levels should be under constant review to ensure that People who use the service have access to their planned activities At least 50 of the staff team should be qualified to NVQ level 2 or above. (ST Erme House, lodge and St Michaels) Makaton/ communication courses should be reinstated to assist staff when communicating with Service users Regulation 26 reports should be forwarded to the Commission so that we are kept up to date with progress made at St Erme. The homes communications books should adhere to the Data Protection Act to ensure that individual records are kept separately and does not breach confidentiality. 4 YA6 YA7 5 6 YA23 YA23 7 8 9 YA24 YA33 YA32 10 YA35 11 12 YA39 YA10 YA41 St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Erme DS0000009149.V366267.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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